Placental pathology in perinatal asphyxia: a case–control study

IntroductionPlacentas of term infants with birth asphyxia are reported to have more lesion such as maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM) and chorioamnionitis with fetal response (FIR) than those of term infants without birth asphyxia. We compared the placental pathology of asphyxiated newborns, including those who developed hypoxic-ischemic encephalopathy (HIE), with non-asphyxiated controls.MethodsWe conducted a retrospective case–control study of placentas from neonates with a gestational age ≥ 35 weeks, a birthweight ≥ 1,800 g, and no malformations. Cases were asphyxiated newborns (defined as those with an umbilical artery pH ≤ 7.0 or base excess ≤ −12 mMol, 10-minute Apgar score ≤ 5, or the need for resuscitation lasting >10 min) from a previous cohort, with (n=32) and without (n=173) diagnosis of HIE. Controls were non-asphyxiated newborns from low-risk l (n= 50) or high-risk (n= 68) pregnancies. Placentas were analyzed according to the Amsterdam Placental Workshop Group Consensus Statement 2014.ResultsCases had a higher prevalence of nulliparity, BMI>25, thick meconium, abnormal fetal heart monitoring, and acute intrapartum events than controls (p<0.001). MVM and FVM were more frequent among non-asphyxiated than asphyxiated newborns (p<0.001). There was no significant difference in inflammatory lesions or abnormal umbilical insertion site. Histologic meconium-associated changes (MAC) were observed in asphyxiated newborns only (p= 0.039).DiscussionOur results confirm the role of antepartum and intrapartum risk factors in neonatal asphyxia and HIE. No association between neonatal asphyxia and placental lesions was found, except for in the case of MAC. The association between clinical and placental data is crucial to understanding and possibly preventing perinatal asphyxia in subsequent pregnancies

Meconium Aspiration Syndrome: A Narrative Review

none6Meconium aspiration syndrome is a clinical condition characterized by respiratory failure occurring in neonates born through meconium-stained amniotic fluid. Worldwide, the incidence has declined in developed countries thanks to improved obstetric practices and perinatal care while challenges persist in developing countries. Despite the improved survival rate over the last decades, long-term morbidity among survivors remains a major concern. Since the 1960s, relevant changes have occurred in the perinatal and postnatal management of such patients but the most appropriate approach is still a matter of debate. This review offers an updated overview of the epidemiology, etiopathogenesis, diagnosis, management and prognosis of infants with meconium aspiration syndrome.noneMonfredini, Chiara; Cavallin, Francesco; Villani, Paolo Ernesto; Paterlini, Giuseppe; Allais, Benedetta; Trevisanuto, DanieleMonfredini, Chiara; Cavallin, Francesco; Villani, Paolo Ernesto; Paterlini, Giuseppe; Allais, Benedetta; Trevisanuto, Daniel

Evaluation of splanchnic oximetry, Doppler flow velocimetry in the superior mesenteric artery and feeding tolerance in very low birth weight IUGR and non-IUGR infants receiving bolus <it>versus</it> continuous enteral nutrition

Abstract Background IUGR infants are thought to have impaired gut function after birth, which may result in intestinal disturbances, ranging from temporary intolerance to the enteral feeding to full-blown NEC. In literature there is no consensus regarding the impact of enteral feeding on intestinal blood flow and hence regarding the best regimen and the best rate of delivering the enteral nutrition. Methods/design This is a randomized, non-pharmacological, single-center, cross-over study including 20 VLBW infants. Inclusion criteria * Weight at birth ranging: 700–1501 grams * Gestational age up to 25 weeks and 6 days * Written informed consent from parents or guardians Exclusion criteria * Major congenital abnormality * Patients enrolled in other trials * Significant multi-organ failure prior to trial entry * Pre-existing cutaneous disease not allowing the placement of the NIRS’ probe In the first 24 hours of life, between the 48th and 72nd hours of life, and during Minimal Enteral Feeding, all infants’ intestinal perfusion will be evaluated with NIRS and a Doppler of the superior mesenteric artery will be executed. At the achievement of an enteral intake of 100 mL/Kg/day the patients (IUGR and NON IUGR separately) will be randomized in 2 groups: Group A (n=10) will receive a feed by bolus (in 10 minutes); then, after at least 3 hours, they will receive the same amount of formula administered in 3 hours. Group B (n=10) will receive a feed administered in 3 hours followed by a bolus administration of the same amount of formula (in 10 minutes) after at least 3 hours. On the randomization day intestinal and cerebral regional oximetry will be measured via NIRS. Intestinal and celebral oximetry will be measured before the feed and 30 minutes after the feed by bolus during the 3 hours nutrition the measurements will be performed before the feed, 30 minutes from the start of the nutrition and 30 minutes after the end of the gavage. An evaluation of blood flow velocity of the superior mesenteric artery will be performed meanwhile. The infants of the Group A will be fed with continuous nutrition until the achievement of full enteral feeding. The infants of the Group B will be fed by bolus until the achievement of full enteral feeding. Discussion Evaluations of intestinal oximetry and superior mesenteric artery blood flow after the feed may help in differentiating how the feeding regimen alters the splanchnic blood flow and oxygenation and if the changes induced by feeding are different in IUGR versus NON IUGR infants. Trial registration number NCT01341236</p

What is the effect of intertwin delivery interval on the outcome of the second twin delivered vaginally?

<p><b>Objective:</b> Optimal management of twin deliveries is controversial. We aimed to assess if intertwin delivery interval, after vaginal delivery of the first twin, may have an influence on adverse neonatal outcomes of the second twin</p> <p><b>Study design:</b> This is a retrospective observational study including diamniotic twin pregnancies with vaginal delivery of the first twin, between January 2000 and July 2017. Inclusion criteria were diamniotic pregnancies and vaginal delivery of the first twin. We excluded higher twin order, monoamniotic pregnancies, cesarean delivery of the first twin and patients with missing data.</p> <p><b>Results:</b> A number of 400 diamniotic twin pregnancies met the inclusion criteria and were divided, considering intertwin delivery interval into (1) ≤30 minutes (<i>n</i> = 365); and (2) >30 minutes (<i>n</i> = 35). Considering the two study groups, maternal and first twin characteristics and outcomes were similar. Second twin reported higher incidence of cesarean section and vacuum delivery, but similar incidence of neonatal adverse outcomes, in case of intertwin interval >30 minutes. At multivariate analysis, a difference between second and first twin weight ≥25% was correlated to neonatal adverse outcome, while we did not found this correlation with a cut-off of 30 minutes.</p> <p><b>Conclusions:</b> In our study, growth discrepancy between twins was significantly correlated to adverse neonatal outcomes, while intertwin delivery time was not an influencing factor. So, in line with this result, in our clinical practice, we do not use a fixed time in which both twins should be delivered, neither in monochorionic nor in dichorionic pregnancies, when fetal wellbeing was demonstrated during labor.</p

Rac1 activation links tau hyperphosphorylation and Aβ dysmetabolism in Alzheimer’s disease

Abstract One of the earliest pathological features characterizing Alzheimer’s disease (AD) is the loss of dendritic spines. Among the many factors potentially mediating this loss of neuronal connectivity, the contribution of Rho-GTPases is of particular interest. This family of proteins has been known for years as a key regulator of actin cytoskeleton remodeling. More recent insights have indicated how its complex signaling might be triggered also in pathological conditions. Here, we showed that the Rho-GTPase family member Rac1 levels decreased in the frontal cortex of AD patients compared to non-demented controls. Also, Rac1 increased in plasma samples of AD patients with Mini-Mental State Examination < 18 compared to age-matched non demented controls. The use of different constitutively active peptides allowed us to investigate in vitro Rac1 specific signaling. Its activation increased the processing of amyloid precursor protein and induced the translocation of SET from the nucleus to the cytoplasm, resulting in tau hyperphosphorylation at residue pT181. Notably, Rac1 was abnormally activated in the hippocampus of 6-week-old 3xTg-AD mice. However, the total protein levels decreased at 7-months. A rescue strategy based on the intranasal administration of Rac1 active peptide at 6.5 months prevented dendritic spine loss. This data suggests the intriguing possibility of a dual role of Rac1 according to the different stages of the pathology. In an initial stage, Rac1 deregulation might represent a triggering co-factor due to the direct effect on Aβ and tau. However, at a later stage of the pathology, it might represent a potential therapeutic target due to the beneficial effect on spine dynamics

Additional file 1: of Rac1 activation links tau hyperphosphorylation and Aβ dysmetabolism in Alzheimer’s disease

Figure S1. Rac1 mutant peptides have high penetration due to the TAT sequence. (A-C) Representative confocal images of cortical neurons treated at DIV3 with different concentrations of TAT-GFP: 5 μM (A), 10 μM (B, C). After treatment, cells were fixed and stained for visualization of dendrites (MAP2) and nuclei (DAPI). Confocal analysis showed that TAT-GFP was internalized (single plane), also in live cells directly imaged 1h after treatment. Scale bars 10 μm. (D) MTT assay on primary cortical neurons after 24h from the administration of 2 μM Rac1 mutant peptides. The cell viability is expressed as % as compared to control. The data represented are mean ±SEM of four independent experiments, each done in triplicate. Figure S2. Aβ1-42 administration does not interfere with Rac1 localization or activation. (A) MTT assay on primary cortical neurons after 24h Aβ1-42 treatment at the indicated concentrations The Aβ peptide suspension was incubated 12h at 4°C prior treatment. The cell viability is expressed as % as compared to control. The data represented are mean ±SEM of four independent experiments, each done in triplicate. One-sample t test to a hypothetical mean of 100% was performed. (B) Representative dot-blot analysis of Aβ1-42 preparations with 6E10 and A11 antibodies. The protein concentration was 0.12 μg for 6E10 and 0.72 μg for A11 (C) Representative confocal images of primary cortical neurons treated with 0.1 μM Aβ1-42 between DIV11 and DIV14. Cells were stained against Rac1-GTP, F-actin, and neurofilament. Scale bars 30 μm. Figure S3. Efficacy of the subcellular fractionation. Representative blots of the subcellular fractionation experiments showing the levels of GluR1, LaminB, and SET in the membrane and nuclear fractions of SH-SY5Y cells. Four independent samples were assessed for the 2 fractions. Figure S4. Tau induced hyperphosphorylation does not alter Rac1 levels or activation. (A) Representative confocal pictures of mature cortical neurons treated with 10nM OA for 6h and immunostained against pS262 tau. Scale bar 30 μm. (B-C) Tau pS262 phosphorylation was analysed by western blot after 3 and 6h from OA administration. The data represented are mean with SEM of four or six independent experiments (3h treatment n=6, 6h treatment n=4). (D-E) Rac1-GTP pull done assay was performed after 3 and 6h from OA administration. The data represented are mean with SEM of three independent experiments. ns, not significant. Asterisks indicate unspecific bands. (DOCX 3215 kb